Stipulated dollar amount established for certain health care services while other services are reimbursed on a cost or fee-for-service basis.
Insurance Encyclopedia
Partially Manageable Risks
are those risks which are at least partially manageable management such as physical damage, liability etc.
Partially repaired damage
Where a ship is only partially repaired, the insured is entitled to the reasonable cost of such repairs plus an allowance for the reduction in the ship’s market value because of the failure to effect full repairs. The aggregate must not exceed the cost of full repairs (Marine Insurance Act 1906, s.69(2)). See UNREPAIRED DAMAGE.
Partially self-funded
See: self-insurance.
Participant
See: beneficiary.
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An individual who is eligible to receive benefits from a health, life, or pension plan.
Participating
A policy that pays dividends to the policy owner. This term can also refer to insurance that pays a portion of the loss, along with other insurance coverage that applies to the same risk.
Participating dentist
State-licensed dentist who has signed a contract with an insurance plan to give dental services to the plan’s members.
Participating hospitals
1. State-licensed hospital that has signed a contract with an insurance plan to provide hospital services to the plan’s members. 2. Inpatient facilities that participate in the Medicare program.
Participating insurance
Type of insurance provision in which the insured is entitled to receive policy dividends that reflect the difference between the premium charged and actual costs. Premiums are calculated to give some margin over the expected cost of the insurance protection. Also called participating policy.
Participating Insurance Policy
(i) Insurance under which the insured is entitled to share in at least some portion of the surplus earnings of the Insurer through dividends, and based on loses experience, investment earnings, and other factors (ii) Insurance or Reinsurance which contributes with other Insurances to cover specified losses.